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09/09/18 Sheila Vakharia

September is Recovery Month, so this week on Century of Lies we speak with Sheila Vakharia, PhD, Policy Manager of the Office of Academic Engagement at the Drug Policy Alliance, about recovery, stigma, and harm reduction.

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DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

Well, September is Recovery Month, and so to find out about recovery, and rehabilitation, and harm reduction, and decriminalization, and stigma, I reached out to a friend, Sheila Vakharia. Sheila Vakharia, PhD, is the Policy Manager at the Office of Academic Engagement for the Drug Policy Alliance. Let's hear that interview.

Tell me about -- what is stigma about?

SHEILA VAKHARIA, PHD: Stigma is a mark that we place on people. It's not a physical mark anymore, as it was historically. It's kind of a social mark that we place on people. Sometimes it's because of something we attribute to their character, or their personhood, or their behavior, or about their ability status.

And so, stigma is often -- it has a negative connotation. It's a mark to characterize someone as having undesirable characteristics, or being immoral, or in some way outside of the norm.

And so when we talk about stigma and substance use, and people who use substances, who kind of have addiction to substances, people who are recovering from substance use disorders, we're really talking about the stigma of the fact that most drug use in this country is illegal and criminalized, and thereby a lot of people who use substances problematically or recreationally are viewed as already outside of the norm, because they're engaging in behavior that is criminalized and seen as deviant.

But, also for people who develop substance use disorders or addictions to substances, there are a lot of myths about how addiction is -- you know, how addiction develops and who gets addicted, and there is this, you know, misconception and this idea that people with issues who maybe lack willpower, or self-control, or restraint, or people who are too indulgent, develop addiction, and so again, all those characteristics being viewed as negative can serve to further stigmatize people who use substances problematically, because they're viewed as people who couldn't seem to keep it under control.

And so, when we talk about stigma and its kind of impact on recovery, we can truly see that if people who use drugs, people who have drugs problems, are stigmatized in this population, obviously, allocating resources towards treatment or developing policies which may be more conducive to facilitating people to make changes and get the support that they need, may be difficult to pass simply because they're already viewed as a population that may not be worthy of the kind of energy and resources we'd like to put into these kinds of systems.

And then when we talk about it being a barrier to people who are already in recovery, a lot of people carry internalized stigma and shame for their past behaviors, because they know that even though perhaps maybe now they're not using problematically or not using at all altogether, but they had an identity that was stigmatized and may still feel some shame and guilt about it, and may not be prone to talk about it, because they don't want it to change how people may view them, now that they've stopped or things have changed for them.

DOUG MCVAY: Stigma can be, it's -- it's a double edged sword in that respect, I guess, then, right? Because it's not only preventing people from stepping forward, and preventing people from trying to seek some kind of help, it's also preventing the broader society from providing that help. That's --

SHEILA VAKHARIA, PHD: Right.

DOUG MCVAY: Oh. That's a -- because, I mean, language, of course, is one way in which that stigmatization is furthered, is sort of driven in. And, I guess, in both ways, the things that you -- when we call people names, they start thinking of themselves that way, that's, I mean, that's textbook child abuse, isn't it? How, you know, call the kid -- call your kid by horrible names and eventually they think of themselves that way?

And that's -- but it's also, what we keep hearing -- tell me about -- you say this better than I do. Tell me about language, and how that impacts.

SHEILA VAKHARIA, PHD: Right. Well, you know, language can reflect how we think about things, but language can also change how we think about things. So, for instance, you know, when we use language which makes the person's relationship with a substance, or their substance use, the most salient thing about them, you know, for instance, when we call someone an addict or a dope fiend, or a junkie, or a crackhead, what we are first doing is conveying to someone that the most salient thing that we see about them is nothing else about their identity other than the fact that they use a substance and perhaps use it problematically.

And, the other thing that happens when we use that kind of language, first of all, is that we convey a message to that person that that's all we think of them, and that's how we see them, which then can be internalized among that, you know, among that whole population and those people, into seeing also that I am nothing more than my relationship with my substance, which can affect self-esteem and self-efficacy, can affect their hopefulness that anything could change or their willingness to perhaps change, because maybe I can't change, if this is what people say I am. Maybe this is a fixed part of my identity. And maybe I can't be anything more than that.

The other thing that that kind of language does to folks who maybe don't fit that category of substance user, is that we, on the outside, start also oversimplifying our views of people. When that kind of language becomes normalized, we think it's okeh to talk to people that way, or to call them that way or to refer to them that way.

For instance, when we see a news story or a media headline that refers to people as addicts, or crackheads, or junkies, or what have you, we start to think, even maybe perhaps before we have any preconceived ideas, this can help facilitate those kinds of ideas, which then make those identities more salient to us.

So, they have the power to influence and shape the way that we think about other groups of people, and in doing so, we lose humanity. Right? We lose our ability to see the humanity of people who use drugs, people who use them problematically, and we also make it hard for them to be able to feel human, and worthy, and deserving of help.

And so, it cuts both ways, and it doesn't help anyone, when we use this kind of terminology. And so one of the biggest things that we do in the harm reduction space and other advocacy spaces is that we're really big proponents of person-first language, putting the person's humanity before their relationship with a substance, in the same way that we would put someone's humanity before any other identity that they have.

So saying, you know, a person who uses substances, or a person who uses whichever substance, because, what it also does is it takes away the labeling and the almost diagnostic element of determining, oh, because you use this substance, that you must be addicted, or me deciding preemptively, before knowing anything about you, that obviously if you're smoking crack that it must be something that you're doing all day long.

So by saying someone who uses crack, someone who uses cocaine, again, we're just simply identifying that perhaps a behavior they engage in. We're not judging the frequency or determining what that means. But, also then it opens us up to say a person who uses cocaine, but also a person who is a mother, who is a father, who is a community member, who is a neighbor, who is a co-worker.

And I think that that is really important. We need more nuance in these conversations, rather than less.

DOUG MCVAY: It -- it's difficult for me to, I've been in this for so long and yet it's still difficult for me to understand how people can not understand these things, and yet, I mean, it's like with rehabilitation and social reintegration. It's a great idea, and it's what we say we want to do when people are exiting, whether it's a treatment program or leaving incarceration, we want them to reintegrate into society, to rehabilitate, but we throw so many barriers up for them.

We make it nearly impossible, I mean, the people who do so successfully, I mean, that's a bloody miracle, because they've overcome so much of what we've done. Why is it, why do you think it is, people -- that we have such a hard time recognizing the way that we do this?

SHEILA VAKHARIA, PHD: I, well, I think that there's two pieces here. So, first of all, recovery is much more natural and much more common than most of us even realize. However, most of those recovery stories are not going to be on the headlines, are not going to be highlighted in a film, they're not going to be the ones that we hear about in our day to day conversations.

Many people have lived their lives in which they've had periods of problematic substance use, or what they would identify as addiction, and people grow out of addiction. People change their relationships with substances. People move on to different phases of their lives. They make other choices. They choose different networks. They move away. They change.

And so much of those narratives, first of all, have never seen the light of day. For instance, Maia Szalavitz recently just wrote this fantastic piece in the New York Times, highlighting recovery stories that don't follow the traditional trajectory, that don't really have the sensationalized, sexy, shocking kind of wow factor that a lot of the stories that we've come to expect have.

And I think that that is one of the biggest shames about even how we frame substance use and recovery, is that we almost want a shocking narrative. We almost want that rags to riches story, or that huge turnaround story, when recovery is quite a normal experience for a lot of people.

And so what I say is that, you know, the people that we do sensationalize, the people who we do kind of point at and say, oh my god, look at this person, look at all they've overcome, are unfortunately the people who perhaps never had a lot of social resources or economic resources, or a lot of support around them during the point in their addiction when they decided perhaps something needed to change.

It's often those people who do need the support and extra assistance to really launch themselves, because what we do know is that social determinants play a huge role in the development of substance use disorders, and the maintenance of them beyond anything else, because when people have so many things in their lives that are lacking or that aren't being compensated for, a substance can be really, really helpful in kind of addressing those issues or at least not having to deal with them head on.

But also, it's those persistent social determinants, when you don't have access to them, that can make recovery really, really hard, because it's hard to think about stopping using my substance when it's the most adaptive thing I have in my life, especially if I'm not getting housed and I need to keep using my substance so at least I'm awake at night, and not being attacked on the street.

Or, if food is really insecure for me and my heroin habit helps suppress my appetite, perhaps there's also a functional element to my heroin use that, unless I'm being, you know, having complete access to food or good, solid access to meals, it's not going to go away.

And so, yeah, I think that there's two pieces there. Right? I think there's the social determinants that need to be addressed for a lot of people who already kind of started their addiction at a disadvantage and who need those supports to be able to pull themselves up, and then the other idea that most people do overcome, but in ways that are generally just not sexy enough to be a headline.

DOUG MCVAY: I actually worried about doing a show about recovery because, in a sense, I feel that focusing on recovery, I mean addiction, it, in a sense, I'm furthering the stigmatization because I know that most people use drugs, and that most people who use drugs do so in a non-problematic way. So, it worried me that, you know, this was, in a sense, going to, going -- that unless, I -- I feel I need to mention that, to make that clear, because other -- I'm afraid of sort of perpetuating the stigma by just starting from the, you know, substance use disorders and addiction and recovery, and ignoring the fact that well, actually, most people use drugs in a non-problematic way.

On the other hand, for people who do have an addiction, and do have these, you know, this is -- it's a real thing, I mean, you know? I overthink things.

SHEILA VAKHARIA, PHD: Yeah, yeah. I mean, I think that, when we talk about recovery, it's important to have nuance, right? So, if we're going to talk about recovery, to talk about it in a way that doesn't perpetuate any sort of mythology or idea that there's only one way to recover, I think that that's like the responsible way for most of us to talk about recovery.

So, you know, having this conversation is always a great opportunity to say that, you know, recovery should be self-defined. I mean, a lot of people in traditional treatment settings, who may be influenced by more traditional substance use kind of lingo and jargon, may have an idea of recovery as being completely abstinence oriented and substance free, particularly your substance of choice, but perhaps other substances as well.

And so, you know, one way to have this conversation in a way that doesn't mythologize recovery or hold it up beyond any other possible outcome is the idea that wellness is recovery, and that people often feel well and can be well and functional in their lives, with or without substances, and I think that that is helpful. And so, yeah, as long as you're creating a space for that conversation, too, I don't think we're upholding it above anything else, because it is a viable outcome for a lot of people and it can look different, and feel different, for different people.

DOUG MCVAY: We're listening to part of an interview I had recently with Sheila Vakharia, PhD. She's Policy Manager at the Office of Academic Engagement for the Drug Policy Alliance. We'll have more of that interview in just a moment.

You're listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

Before we go further, you know, probably it would help if we actually understood what recovery means. It's a word that we hear all the time, but, what exactly is it supposed to mean?

Back in 1994, the World Health Organization's lexicon of alcohol and other drug terms defined recovery as quote "Maintenance of abstinence from alcohol and or other drug use by any means." End quote.

Now, there's also the idea of rehabilitation. That World Health Organization lexicon defined rehabilitation as, quote, "The process by which an individual with a substance use disorder achieves an optimal state of health, psychological functioning, and social well being." End quote.

In the last few decades, the idea of recovery has evolved. An excellent article back in 2010 by David Best and colleagues, called "Recovery and Straw Men: An Analysis of the Objections Raised to the Transition to a Recovery Model in UK Addiction Services," published in the Journal of Groups in Addiction and Recovery, again back in 2010, quote:

"The target of recovery is about quality of life, rather than abstinence, although abstinence may be a long term goal for clients. However, the underlying theoretical model for much recovery work is the developmental or lifecourse model, which would suggest a significant lengthening of the time scale for the recovery process, and so the focus on change -- whether to the point of abstinence -- is a long term journey that may well take up the rest of a person's life. So abstinence orientation may well be something that either does not ever occur, or at least is not a viable goal. It is also this approach to addiction and recovery careers that means harm reduction does not have to be characterized as the antithesis of recovery." End quote.

And so with that in mind, let's get back and hear more of that interview with Doctor Sheila Vakharia.

Okeh. And I'm -- this last one is, this last one is actually difficult, but I've, it's just that I've been -- earlier today, I was playing a lot of Whack-A-Troll, trying to respond to some really, really viciously hateful kinds of comments on message boards and on Facebook.

I mean, these people -- basically, these people were saying that they thought that, you know, things like supervised injection or some harm reduction things are just enabling, and that they would just rather to see the, you know, to see your child die, because they deserved it from having used those drugs. They'd rather see them die, because, you know, otherwise we're just enabling.

Just because they're -- I mean -- the FCC wouldn't let me say what I'm thinking about people like that. How can people respond effectively to that kind of, to someone who's just, whose attitude is, oh, any, that's just enabling, we just have to toughen up law enforcement and if a few people die, well, that's just how things go. You know.

SHEILA VAKHARIA, PHD: Well, I think that the best way to do it is with compassion. So, you know, those of us in the, you know, in the treatment space talk about, you know, stages of change, and how, you know, people go through different, you know, mental and emotional processes as they decide to move towards change.

I don't know if you're familiar with the stages of change theory, the transtheoretical model?

DOUG MCVAY: Uh ... tell me --

SHEILA VAKHARIA, PHD: Have you heard of it?

DOUG MCVAY: Well, for the benefit of our listeners, well of course I've heard of that, but for the benefit of our listeners, ha ha ha.

I have no idea what you're talking about.

SHEILA VAKHARIA, PHD: So, I mean -- so, sure. So, you know, in the treatment space, we often talk about it, you know, as a way to destigmatize drug use and people who use drugs problematically, but also as a way to, you know, have more compassion and understand how people change, and we talk about this model called the transtheoretical model of change, which says that, you know, change doesn't just happen overnight, and it requires a lot of mental and emotional preparation before one is often ready to make a change.

And then even sometimes after we've made a change, you know, you may have some backsliding and you may need to recommit to the goal that you've been working towards. So I often use the kind of analogy of, like, weight loss. You know, someone doesn't just think overnight, oh, I need to lose weight. Oftentimes, they think their weight is fine, but then perhaps clothes don't start fitting, or they start noticing they look a little different in the mirror, and so they go from being pre-contemplative, meaning thinking, oh, everything's fine, there's no problem, to contemplative, thinking oh, huh, maybe I've been gaining a little weight, maybe things aren't sitting well, maybe I haven't been paying enough attention to my workout regimen or to what I've been eating.

Oftentimes before someone just jumps into a diet, it often takes some preparation, some planning. So, now that I've noticed that I've put on some weight, what are some strategies that I can engage in? I could think about going on a diet. I could just buy bigger clothes. I could think about working with a dietitian or a nutritionist. I could think about getting a gym membership.

And then, you know, after going through that preparation process, [inaudible], a lot of us have ambivalent feelings about our weight and our bodies, but often don't do much about them. So, you know, you get to the point where you're on the option phase, and you may decide, okeh, well I'm going to try that new workout regimen. I'm going to buy the gym membership, I'm going to start going and this is going to be my new routine.

And the action phase is kind of when you jump off and launch into this new kind of way of doing things, and living your life, and engaging with things, and you know, after a while, you may be in the maintenance phase, where it's just like it becomes a normal part of who you are.

But perhaps maybe in the first six months or so, you get busy and you stop going to the gym, and you think to yourself, well, maybe I'm doing okeh and I don't need to go back, and I slip back into my old thinking that I don't need to be doing this.

But anyway, with that weight loss metaphor, I often use that metaphor with my clients who use drugs to get them to think about, you know, like, where are you in the stages of change? Like, do you think you're used to the problem? Do you think that, you know, you need to cut down? Do you think you need to stop altogether?

But, I think that it's also really important to use that stages of change model when thinking about people who don't think the same way that we do. So perhaps, you know, someone who's saying something like, well, let those people die, they don't deserve help, they, you know, they're just a drain on society, are people who are pre-contemplative to harm reduction.

So, because they've never heard of harm reduction, because no one's ever challenged their thinking and given them a reason to kind of look at things differently, maybe they just need a little bit of help being moved.

And so instead of expecting them to be in the action phase, of being a harm reduction advocate right away, I have to think about how do I get them to the contemplation stage? I'm just kind of seeing some of the shortfalls of some of their arguments, or seeing some of the limitations of their arguments, or starting to see some of the exceptions to the things that they think are the rule.

So, in having compassion for an angry tweeter or facebook commenter who says, well, let those people die, you know, to come at them and expect them to be at the same level of understanding that someone like us is, is perhaps unreasonable and could also like shut down the conversation. Right?

And so I think an important way to get someone from pre-contemplative into contemplative is to really explore what the roots are of what those thoughts are, what those beliefs are. And oftentimes, what you hear from people who hold those stances is that either they've never met someone with an addiction and so they're basing it completely on sensationalized stories in the media and things that they've seen in the news or on TV, and so, you know, having a conversation about, you know, well, what kind of headlines do you pop up in the news versus what do people see in reality, can be a helpful way to get them to start reflecting on what they're thinking.

But then what we also see is that some people who have those extreme thoughts, actually their mom was addicted. Their brother is currently addicted. Their partner cannot stop using. And oftentimes that attitude is formed from a place of anecdotal, first hand experience, which may be really challenging and harmful and hurtful to them, that they don't really understand and so that they're reacting with a lot of anger, but often sometimes that anger is grounded in hurt and feeling of powerlessness and being like, well, I don't know what to do with myself and with my stuff and like all those other people, and they do seem to give up on those people. Do you understand what I'm saying?

DOUG MCVAY: I do. I do. I do, I wish I'd had -- I wish we'd had this conversation before I started playing Whack-A-Troll, and hopefully moving forward I'll be a little more understanding. I don't know if it will work, but I'll try. I mean, you've got to try.

SHEILA VAKHARIA, PHD: Yeah. Yeah, and so you know, like kind of coming at the, you know, those folks with -- you know, from a place of compassion in the same way that I would with a client who still wasn't sure what they wanted to do about their drug use, you know, or someone who may not see the harms of sharing syringes, or may not see that perhaps they should keep naloxone on hand, and who think that things are just fine the way that they are.

In the same way, you know, it's really important to ask questions, to find out where they're -- what their beliefs are, what are their beliefs grounded in, are there some personal experiences, are there just kind of limited information, and to really have compassion to the fact that people hold these opinions oftentimes as a way to protect themselves from feeling, you know, too strongly about, you know, feeling out of control, or they're doing it as a reaction because they haven't gotten all the information.

And so, you know, I find myself, even when I am myself in those conversations, I bristle initially, and I'm like, oh, gosh, what do I say? But then, I have to recalibrate and check myself and think to myself, they're not where I am, but, like, how can I get them there?

Until I -- and I can't get them anywhere until I understand what's informing this stance. And then, when I can understand where that stance is coming from, I can better have compassion for this person as holding this opinion because of limited information, or because they're struggling themselves, and then I can then better tailor my message in a way that they can understand.

DOUG MCVAY: What she said.

Sheila, do you have any closing comments, we're getting close to the end of the hour, do you have any closing comments for our listeners, and I want to get, you know, any websites, and your social media stuff, too, so people can follow your work.

SHEILA VAKHARIA, PHD: Yeah. Well, I mean, so, I'm on Twitter, so I can be followed at @MyHarmReduction. And I recommend checking out the Drug Policy Alliance webpage, which is DrugPolicy.org, where you can get a lot of really great information about drugs, what they do in the body, different kinds of options for getting people help, and understanding, you know, what drugs do.

You can also get more information about some of the policy work that we're doing on a national level as well as in the states that we're located in. And then, you can also sign on to some of the petitions that we have circulating. Right now, we've got a great petition that you can sign onto through our main webpage, in which you can actually send a message a message to your Senator, your state senator, telling them that you support supervised consumption spaces, and that you find, that you've seen some issues with, you know, the discourse coming out of Rod Rosenstein lately, and, you know, the ways in which this administration is trying to push back against supervised consumption spaces.

So, we've got a template letter already there that you can just send, or you can go in and modify it, and it will send directly to your senators. So we've got actions like that, that happen all the time. You can sign up for our newsletter, and be up to date on what's happening in your state, and ways in which you can get involved.

DOUG MCVAY: Sheila, I thank you so much for your time, and all the great work that you're doing. I want to have you back on the show again sometime soon, we'll talk more about the criminalization side, because this is --

SHEILA VAKHARIA, PHD: Okeh. Well, thank you so much for having me, this is great.

DOUG MCVAY: That was my interview with Sheila Vakharia, PhD, Policy Manager of the Office of Academic Engagement for the Drug Policy Alliance.

NGAIO BEALUM: While marijuana's legal on the west coast, and Alaska and a lot of different places, it is still illegal in most of the country, right? So while these cats are out here making millions of dollars and everybody's got a cannabis business and we're all smoking weed in the streets, there are people in other states who are still in jail over a joint, who got fifteen years on two grams, who got arrested for a gram and a half of weed.

It's not over. We still need activists. We still need radicals. We still need to be in the streets, like, I've updated one of my new jokes about how what we need to do is just roll out from the west coast to all these others states, and just start going door to door, like Weedhova's Witnesses, and getting everybody involved.

I have some good news about weed, can I share it with you? Right? I'd like to talk to you about my faith in the cannabis hemp plant.

DOUG MCVAY: And that's all the time we have this week. Thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about drug policy reform and the drug war. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.